Has the Government watered down its drugs strategy?

Has the Government really watered down its drugs policy, as some are saying? Certainly the new Drug Strategy rejects the idea of cutting the benefits of addicts who don't cooperate with treatment, which was the tough-love approach championed by Iain Duncan Smith and others over the summer. Now, the document says addicts will not be targeted with special sanctions: instead, there's talk of "incentives" that might be built into the new universal credit system, designed to reward those who engage with treatment. And although the strategy's declared goal is abstinence, this is qualified: medical treatments remain useful, the Government thinks, if they reduce harm and enable people to rebuild their lives. This includes the prescribing of pure heroin for a minority of patients.

All in all the strategy does sound less hardline than the rhetoric we heard over the summer and in the run-up to the general election. I think this represents an acknowledgment that solving the problem of addiction is not straightforward. Some realism has crept in. Every new administration likes to look strong and decisive about the drugs question. Dependence on heroin and crack cocaine seems so intractable, and the crime that results causes such misery. A new Government naturally wants to persuade people that it has some fresh thinking. The trouble is, addiction to illegal drugs has been a significant social problem for several decades now. Most approaches have been tried before and you inevitably see a pendulum effect, where policy swings from punitive and harsh to pragmatic.

In the end pragmatism usually wins through, for the simple reason that addicts obstinately refuse to recover just because they're forced to. Recognising this, Mrs Thatcher's government first introduced so-called "harm reduction" on a wide scale. Circumstances required measures that actually worked. The country was facing the spread of Aids, a deadly blood-borne virus, through the sharing of injecting equipment by addicts. Fear of widespread deaths and of a plague spreading into the healthy population encouraged methadone prescribing as an effective way of stabilising the lives of chaotic drug users. Methadone banished unpleasant withdrawal symptoms, discouraged addicts from seeking illegal drugs and cut crime. It was also cheap. And it brought the street addict into the system, into contact with medical staff, counsellors and people who could nudge them towards sorting their lives out. The harm reduction policy – which also meant providing sterile injecting equipment – succeeded in reducing the harm caused by the illegal drugs. It did not do much, however, to reduce the overall number of addicts.

Since those days, methadone and other replacement drugs have become the remedy of choice for persistent opiate addiction in patients who refuse or are unable to stop. It's used all over the world, and now even previously resistant countries like China and Russia are said to be experimenting with it. There's no medical treatment for crack, yet: a cocaine "vaccine" is in development. There are drugs which reduce cravings for alcohol. Some 12-step enthusiasts disapprove of using medicine to treat addiction, but my feeling is one should not be dogmatic about it. If medicines help and doctors think they're a good idea, why not?

With the new Conservative-led Coalition, the pendulum looked as though it was swinging in the other direction. Iain Duncan Smith and his thinktank, the Centre for Social Justice, spoke to individuals who had experienced drug dependency and were inspired by this experience to take a firmer grip. They became almost evangelical about it. This explains why yesterday's policy document had a strong emphasis on abstinence as the goal.

No addicted person should be considered beyond hope of abstinence. But as anyone who has known an addict will tell you – and the same applies to alcoholism – some people will take longer than others. The new strategy accepts this, hence the slight softening of the emphasis on abstinence at all costs that we used to hear from Mr Duncan Smith, and the acknowledgment of the role "medically-assisted recovery" can play. In the end recovery is down to the individual, whether he or she actually wants to get better. Creating the conditions for this desire to flourish is key – it's what in the strategy they call "recovery capital", meaning the structures that support recovery: family, home, work, health etc. You could force thousands of half-hearted patients into residential treatment centres, hoping that they'll emerge after six weeks having magically achieved abstinence. But it would be a waste of time – and money. And it might cause more harm than good.